Page 2 of 2 FirstFirst 12
Results 11 to 18 of 18

Modifier 78 or 79?

  1. #11
    Location
    Milwaukee WI
    Posts
    4,466
    Default Return to OR?
    Exam Training Packages
    Ortho is NOT my area of expertise, but ...

    If the removal of hardware and I&D were done under anesthesia in an operating room then you are NOT just taking over postoperative care from Dr B. If you returned the patient to the OR I would use the 79 modifier as it is unrelated to the previous surgery Dr A performed (and therefore NOT covered in the postoperative period for Dr A's procedure).

    On the other hand ... If this was done in the office suite, I would not code for it at all. Why? Because Dr A is already seeing the patient in a postoperative global period for the menisectomy and MCL open repair. (Unless the injuries were to different legs ... e.g. Dr A on right leg, Dr B on left leg ... then I'd code the same CPT as Dr B did with a -55.)

    Gosh, this IS complicated!

    F Tessa Bartels, CPC, CEMC

  2. #12
    Location
    Long Island/New York
    Posts
    1,271
    Question
    Quote Originally Posted by FTessaBartels View Post
    Ortho is NOT my area of expertise, but ...

    If the removal of hardware and I&D were done under anesthesia in an operating room then you are NOT just taking over postoperative care from Dr B. If you returned the patient to the OR I would use the 79 modifier as it is unrelated to the previous surgery Dr A performed (and therefore NOT covered in the postoperative period for Dr A's procedure).

    On the other hand ... If this was done in the office suite, I would not code for it at all. Why? Because Dr A is already seeing the patient in a postoperative global period for the menisectomy and MCL open repair. (Unless the injuries were to different legs ... e.g. Dr A on right leg, Dr B on left leg ... then I'd code the same CPT as Dr B did with a -55.)

    Gosh, this IS complicated!

    F Tessa Bartels, CPC, CEMC
    Same leg, Multiple injuries from a single motorcycle accident. Dr B performed a repair on 1 aspect of the injury (ORIF) while my doc, Dr A, performed a surgery (menisectomy, MCL repair) on another injury/part of the same knee/leg. Dr A then took the patient back to the OR for removal/debridement of Dr B's ORIF procedure.

    My Dr already plans (Staged as he noted in op-report #2) for more repairs/surgeries. The thing is that this patient had multiple injuries that needed to be addresses from a single accident. Just want to make sure I use correct modifier. The research I've done on modifier 55 is, as it seems to me, that a Dr took over the post-op services and that you should report the original surgical code with the 55 modifier. That would be fine if it was just office visits but my Dr took him back to the OR to complete/rectify the other Dr's surgery...Very confusing

  3. #13
    Location
    Milwaukee WI
    Posts
    4,466
    Default Back to the OR is NOT post-op care
    Taking the patient back to the OR is NOT post-op care and those procedures are separately reported. So forget about the -55 modifier for now.

    Also you have never answered the question of whether these two doctors are in the same practice and of the same specialty. If they ARE, they are considered the same doctor, so use the -78 modifier. If they are different practice or different specialty use -79 modifier.

    Also, if they are in the same practice/same specialty then you cannot report Dr B's procedure w/ a 55 modifier for Dr A. Regardless, I would not code ANY office visits ... not even when Dr A is looking at original wounds from surgery done by Dr B. I do not think there is sufficient extra work being done in these evaluations over and above what Dr A would do for his OWN postoperative care of the patient. (Think of it this way ... If Dr A had done all the procedures himself, he wouldn't code two postoperative visits for one encounter ... would he?)

    As Dr A has now indicated that the patient will need to go back to the OR for a series of procedures, you'll be using the -58 modifier for each return to OR for these "staged or related" procedures.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #14
    Location
    Columbia, MO
    Posts
    12,561
    Default
    I agree if this was a return to an OR then it would be either 78 or 79, from the original submission it looked like an office encounter.

    Debra A. Mitchell, MSPH, CPC-H

  5. #15
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Quote Originally Posted by FTessaBartels View Post
    Taking the patient back to the OR is NOT post-op care and those procedures are separately reported. So forget about the -55 modifier for now.

    Also you have never answered the question of whether these two doctors are in the same practice and of the same specialty. If they ARE, they are considered the same doctor, so use the -78 modifier. If they are different practice or different specialty use -79 modifier.

    Also, if they are in the same practice/same specialty then you cannot report Dr B's procedure w/ a 55 modifier for Dr A. Regardless, I would not code ANY office visits ... not even when Dr A is looking at original wounds from surgery done by Dr B. I do not think there is sufficient extra work being done in these evaluations over and above what Dr A would do for his OWN postoperative care of the patient. (Think of it this way ... If Dr A had done all the procedures himself, he wouldn't code two postoperative visits for one encounter ... would he?)

    As Dr A has now indicated that the patient will need to go back to the OR for a series of procedures, you'll be using the -58 modifier for each return to OR for these "staged or related" procedures.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Yes different practices.

  6. #16
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Quote Originally Posted by mitchellde View Post
    I agree if this was a return to an OR then it would be either 78 or 79, from the original submission it looked like an office encounter.
    No it was for surgery not office visit.

  7. #17
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I'm with Tessa on this one---79 modifier would be appropriate for a return to the OR for an unrelated (to the 1st procedure).
    Mary, CPC, CANPC, COSC

  8. #18
    Default
    Modifier 55 Post Opertative Management Only; Reimbursement 70% most payers; 80% Florida Medicare

Page 2 of 2 FirstFirst 12

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.